利培酮与奋乃静治疗老年期痴呆精神症状的对照研究

目的　比较利培酮与奋乃静治疗老年期痴呆患者精神症状的疗效、不良反应及对认知功能的影响。方法　将符合条件的60例老年期痴呆患者随机分为利培酮组和奋乃静组(各30例)。治疗8周。采用一般情况调查表(自编)、临床疗效评定量表(CGI)、阿尔茨海默病病理行为评分表(BEHAVE AD)、简易智力状态检查(MMSE)及药物不良反应量表(TESS)分别进行疗效、不良反应和认知功能评估。结果　两组临床总体疗效比较:有效率分别为86. 67%和83 .33%,无显著性差异(P>0 .05)。两组BEHAVE AD评分治疗前后比较均有非常显著差异(P<0. 05,P<0 .01),治疗结束后两组间BEHAVE AD评分无显著差异(P>0 .05)。治疗结束后MMSE评分利培酮组较奋乃静组高,有显著差异(t=2 .26,P<0 .05 )。两组不良反应发生率无显著性差异(χ2 =0 .28,P>0 .05)。结论　利培酮与奋乃静对老年期痴呆的精神症状疗效、不良反应相近,但对认知功能的影响优于奋乃静,故利培酮更适合于伴有精神症状的老年期痴呆患者的治疗。     

喹硫平和利培酮治疗老年痴呆精神行为障碍的疗效研究

目的观察喹硫平和利培酮治疗老年痴呆精神行为症状的疗效和安全性。方法将60例老年期痴呆患者随机分为喹硫平组30例,利培酮组30例,共观察8周。治疗前及治疗后第2,4,8周分别采用AD病理行为评定量表（BEHAVE-AD）评定疗效;采用TESS量表评定不良反应。结果治疗前后两药的疗效相似（P〉0.05）。但治疗2周,4周时攻击行为和昼夜节律紊乱因子,喹硫平组疗效优于利培酮组,且存在显著差异（分别是P〈0.01,P〈0.05）。喹硫平组不良反应较利培酮组少。结论喹硫平治疗老年期痴呆精神行为障碍疗效与利培酮相当,但不良反应较利培酮少,更适用于老年患者。     

The GBS scale in multi-infarct dementia and senile dementia of Alzheimer type

The GBS profile was assessed for 39 patients with multi-infarct dementia (MID) and 34 patients with senile dementia of Alzheimer type (SDAT). The MID patients fulfilled the DSM-III criteria for multi-infarct dementia and had a score of 7 points or more on the Hachinski Ischemic Scale (HIS) and a score of 4 points or less on the Gustafson/Nilsson Alzheimer Scale (GNAS). The SDAT patients fulfilled DSM-III criteria for primary degenerative dementia and had a score of 5 points or more on the GNAS and a score of 6 points or less on the HIS. The total GBS score, the GBS subscale and relative subscale scores for intellectual functioning were significantly higher in patients with SDAT as compared with patients with MID. However, these subscale scores were considerably dispersed and nearly totally overlapping between patients with MID and SDAT, which implicates that the discriminative value is minimal. The validity between the GBS versus HIS and between the GBS versus GNAS was divergent, suggesting that the GBS scale has its own unique validity. In conclusion, the study does not support the hypothesis that the GBS profile may be of diagnostic value in clinical differentiation between multi-infarct dementia (MID) and senile dementia of Alzheimer type (SDAT).     

A comparison of the Cohen-Mansfield agitation inventory with the cerad behavioral rating scale for dementia in community-dwelling persons with Alzheimers disease

In a group of 242 community-dwelling patients with Alzheimers disease (AD), a longitudinal comparison was made of two caregiver-administered instruments for assessment of behavioral disturbance; the Cohen-Mansfield Agitation Inventory (CMAI) and the CERAD Behavioral Rating Scale for Dementia (BRSD). We examined records of the 206 patients with baseline and 12-month follow-up data for the CMAI and the BRSD who also had tests of cognitive (Mini-mental State; MMSE) and global function (Clinical Dementia Rating; CDR and Functional Assessment Staging; FAST). Among 114 AD subjects, the correlation between total CMAI at baseline and 1 month readministration was 0.83 (p<0.0001). In the same subjects, stratified into 5 groups by MMSE scores, the correlations between BRSD baseline and 1-month scores ranged from 0.70–0.89 (p<0.0001). There was high correlation between total scores of both instruments at baseline and 12 months. In addition, all CMAI subscales except Verbally Aggressive correlated significantly with total BRSD score at both time points. At baseline, BRSD subscales for irritability\aggression, behavioral dysregulation and psychotic symptoms and at 12 months, irritability\aggression and behavioral dysregulation correlated with total CMAI scores. Neither scale changed significantly over 1 year, but there was wide individual variation. CMAI and BRSD scores correlated with 1-year change in the FAST, but not with MMSE or CDR (which weighs cognition heavily), suggesting that behavioral disturbance may be more strongly related to ability to manage activities of daily living (executive function) than to other aspects of cognition. The CMAI and BRSD appear to be interchangeable as measures of agitation, with the CMAI possibly more useful for patients who lack language and the BRSD more sensitive to apathy and depression.     

老年性痴呆患者血清叶酸和维生素B12的临床观察

目的　了解老年性痴呆患者叶酸和维生素B12 水平 ,并探讨二者与痴呆的关系。方法　研究对象为 6 0岁以上的老年人 10 4例 ,患有老年性痴呆者 76例 ,其中老年性痴呆 (AD) 33例 ,血管性痴呆 (VD) 4 3例 ,健康老年者 2 8人作为对照组。对所有研究对象进行临床病史询问、内科和神经科查体 ,空腹取血检测血清叶酸和维生素B12 。结果　老年性痴呆患者叶酸的平均水平为 (7.6 5± 2 .4 8)ug/L(AD)和 (8.5 4± 3.34)ug/L(VD) ,维生素B12 的平均水平为 (312 .4 3± 182 .5 )ng/L(AD)和 (713.5 8± 6 2 5 .94 )ng/L(VD) ,对照组叶酸和VitB12 的平均水平分别为 (11.35± 3.76 )ug/L和 (5 0 7.8± 4 5 2 .85 )ng/L ,分别与对照组比较有显著性差异 (P <0 .0 5 )。结论　老年性痴呆者与血清低叶酸水平有关 ,而与低维生素B12 水平无关。     

住院老年期痴呆患者监护人生活质量及其影响因素

目的探讨住院老年期痴呆患者监护人生活质量及其影响因素。方法采用一般情况调查表、健康状况问卷（SF-36）、社会支持评定量表（SSRS）、简易智力状态检查（MMSE）、AD病理行为评分表（BEHAVE-AD）对住院老年期痴呆患者及门诊老年期痴呆（AD和VD）患者和其监护人进行评定,并与正常老人的监护人进行比较。结果住院痴呆患者监护人SF-36总分及因子分比正常对照低,但较门诊痴呆组评分高,均有显著性差异（P〈0．01-0．05）。单因素分析发现不同性别、年龄、文化程度、婚姻状况、工作情况、性格特征、病程、与患者的关系及有无躯体疾病之间比较,其SF-36总评分均具有非常显著性差异（P〈0．01）;逐步回归分析显示影响监护人生活质量的因素依次为患者痴呆的严重程度,精神行为症状,与患者关系,性别,社会支持。结论住院痴呆患者监护人生活质量较差,影响因素是多方面的,应引起高度重视。     

住院老年痴呆患者的病情严重程度及其有关因素分析

目的了解住院老年痴呆患者的病情严重程度及其影响因素.方法76例住院痴呆患者,其中AD42例,MID34例,平均年龄(75.89±8.04)岁,平均病程(4.94±3.15)年,平均住院时间(2.27±2.06)年,评定工具为MMSE、ADL、ADSS、SBS和PANSS.结果不同性别和文化程度的中晚期痴呆患者的认知功能,日常生活能力无显著差异,AD和MID之间各量表分也元差异(P＞0.05),痴呆程度较重的患者异常行为和锥体外系征发生率及程度均较高(P＞0.05).结论AD和MID至后期痴呆时已无临床差异,不同性别、不同文化程度对中晚期痴呆严重程度的影响不大.但男性、文化程度低、PANSS、RSESE分高的患者痴呆发展速度较快.     

南昌市区老年期痴呆的现况调查

目的了解南昌市区老年期痴呆的患病率。方法采用整群分层抽样方法，对南昌市区4个居委会，共计2126名≥60周岁老年人进行老年期痴呆的流行病学调查。结果老年期痴呆的患病率4．19％，其中阿尔茨海默病(AD)患病率3．39％，血管性痴呆0．66％，其他原因所致痴呆0．33％。结论老年期痴呆已成为危害老年人健康的重要疾病之一，且对社会和家庭的影响非常大．应引起高度重视。     

老年期痴呆患者亲属的心理健康状况

目的探讨老年期痴呆患者亲属的心理健康状况。方法应用症状自评量表(SCL-90)、社会支持评定量表(SSRS)、防御方式问卷(DSQ)评定了71例老年期痴呆患者亲属(研究组)并与80例健康人(对照组)进行比较。结果老年期痴呆亲属SCL-90总分(t=6.970,P<0.001)、躯体化(t=2.876,P=0.005)、抑郁(t=2.696,P=0.008)及焦虑(t=2.736,P=0.007)因子分高于对照组。防御方式以不成熟(t=7.394,P<0.001)及中间型防御方式(t=3.143,P=0.002)为主。多元逐步回归分析显示不成熟防御因子分、躯体疾病、对支持的利用度对SCL-90总分影响大。结论老年期痴呆患者亲属存在心理健康问题且与其不成熟防御方式、对支持的利用度低及患者躯体疾病有关。     

The assessment of orientation in dementia: Item content versus item format

Orientation assessments with regard to time, place and person tend to show a typical pattern of deterioration in progressive dementias. Some clinicians have established hierarchies of orientation based on these observed paterns. There are discrepancies in the order of these hierarchies, due perhaps to differences in the phrasing of questions asked of patients. It is possible to vary the difficulty of items by changing the question format and evidence is cited to show that format differences may be especially pertinent to demented populations. In two large samples of psychogeriatric subject frequencies of incorrect responses for individual orientation items were calculated along with probabilities of success based on chance responding. Results show that although the traditional contentbased hierarchy was observed, simple probabilities of success could also account for the observed frequencies of incorrect responding.